Anatomy of a Community Benefits Report

1. Anatomy of a Community Benefits Report Amanda Greene, Program Chief, Community Benefits, HSCRCAnne Hubbard, AVP, Financial Policy & Advocacy, MHA

2. Community Benefit Reporting Requirements • Community Benefit Narrative Report • I. General Hospital Demographics and Characteristics • II. Community Health Needs Assessment • III. Community Benefit Administration • IV. Hospital Community Benefit Program and Initiatives • V. Physicians • Appendices • Financial Assistance Policy • Hospital Vision, Mission and Value Statement • Community Benefit Reporting Tool • Medicaid Costs • Community Health Services • Health Professions Education • Mission Driven Health Services • Research • Cash and In-Kind Contributions • Community Building Activities • Community Benefit Operations • Charity Care • Foundation Funded Community Benefit

3. The Narrative Report

4. I. General Hospital Demographics & Characteristics • “Primary Service Area” means the Maryland postal ZIP code areas from which the first 60 percent of a hospital’s patient discharges originate during the most recent 12 month period. • This information is provided by the HSCRC Table 1 Evaluation Criteria = Zero Points

5. I. General Hospital Demographics & Characteristics 2.a. Describe in detail the community or communities the organization serves. This is considered the Community Benefit Service Area. Evaluation Criteria = 0 - 6 points Brooklyn/Curtis Bay/Hawkins Point—ZIP Codes 21225 and 21226 This neighborhood is more racially diverse than either South Baltimore or Cherry Hill, with a 24%African-American population and a 69% Caucasian population; in Cherry Hill the percentages are 97% and 1%, respectively, while in South Baltimore they are virtually reversed at 2% and 95%, respectively. This area contains a large number of chemical plants and other industrial sites, including several Superfund-qualified locations. The poverty level in this community is slightly higher than that of Baltimore City, with 48% of families earning less than $25,000 annually, as compared to 43% of all Baltimore families. The life expectancy here is 69.3 years. Heart disease and cancer, once again, rate highest in terms of causes of death and years of potential life lost, causing 28% and 22% of deaths, respectively. (Excerpted from Harbor Hospital FY 2011 CBR)

6. I. General Hospital Demographics & Characteristics • 2.b. Hospitals are asked to describe significant demographic characteristics and social determinants that are relevant to the needs of the community and include the source of the information for each response. • Social determinants are factors that contribute to a person’s current state of health. They may be biological, socioeconomic, psychosocial, behavioral, or social in nature. • Examples include gender, age, alcohol use, income, housing, access to quality health care, education and environment, having or not having health insurance. • Some statistics may be accessed from the Maryland State Health Improvement Process (http://dhmh.maryland.gov/ship/) and its County Health Profiles 2012 (http://dhmh.maryland.gov/ship/SitePages/LHICcontacts.aspx) , the Maryland Vital Statistics Administration (http://vsa.maryland.gov/html/reports.cfm), the Maryland Plan to Eliminate Minority Health Disparities (2010-2014) (http://www.dhmh.maryland.gov/mhhd/Documents/1stResource_2010.pdf ), the Maryland ChartBook of Minority Health and Minority Health Disparities, 2nd Edition (http://dhmh.maryland.gov/mhhd/Documents/2ndResource_2009.pdf)

7. Table 2 Excerpted from Suburban Hospital’s FY 2011 CBR

8. Table 2 cont. Excerpted from Suburban Hospital’s FY 2011 CBR

9. Table 2 cont. Excerpted from Suburban Hospital’s FY 2011 CBR

10. Table 2 cont. Evaluation Criteria = 0 - 6 points Excerpted from Suburban Hospital’s FY 2011 CBR

11. II. Community Health Needs Assessment • A CHNA is a written document developed for a hospital facility that includes a description of the community served by the hospital facility: • The process used to conduct the assessment including how the hospital took into account input from community members and public health experts; • Identification of any persons with whom the hospital has worked on the assessment; • And the health needs identified through the assessment process. Evaluation Criteria = 0 – 70 points • The Implementation Strategy must: • Be approved by an authorized governing body of the hospital organization; • Describe how the hospital facility plans to meet the health need; or • Identify the health needs as one the hospital facility does not intend to meet and explain why it does not intend to meet the health need. Evaluation Criteria = 0 – 20 points *Hospitals must provide links to both their CHNA and Implementation Strategy Documents

12. III. Community Benefit Administration • Please answer the following questions below regarding the decision-making process of determining which needs in the community would be addressed through community benefits activities of your hospital? • A. Is Community Benefits planning part of your hospital’s strategic plan? Yes or No? • What is a strategic plan? What counts? • Part of a hospitals broader strategic plan • A stand alone hospital strategic plan or policy Evaluation Criteria = 5 points

13. III. Community Benefit Administration • B. What stakeholders in the hospital are involved in your hospital community benefit process/structure to implement and deliver community benefit activities? • Senior Leadership • ___CEO • ___CFO • ___Other (please specify) • Clinical Leadership • ___Physician • ___Nurse • ___Social Worker • ___Other (please specify) • Community Benefit Department/Team • ___Individual (please specify FTE) • ___Committee (please list members) • ___Other (please describe) Evaluation Criteria = 15 points

14. III. Community Benefit Administration • C. Is there an internal audit (i.e., an internal review conducted at the hospital) of the Community Benefit report? • Spreadsheet _____yes _____no • Narrative _____yes _____no • D. Does the hospital’s Board review and approve the completed FY Community Benefit report that is submitted to the HSCRC? • Spreadsheet _____yes _____no • Narrative _____yes _____no Evaluation Criteria = 12 points

15. IV. Hospital Community Benefit Program & Initiatives • Hospital Implementation Strategy Initiatives Evaluation Criteria = 20 points

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17. IV. Hospital Community Benefit Program & Initiatives • Were there any primary community health needs that were not addressed by the hospital? If so, why not? • We recognize that we cannot pursue all of the identified health needs and that choices need to be made. We made choices using a rigorous process to ensure that documented unmet community health needs intersect with our mission commitments and key clinical strengths. At this time, behavioral health has not been incorporated into our community benefit plan because it is not a key clinical strength of the hospital and we do not have the infrastructure needed to sustain programs that would make an impact in this area. However, although we currently cannot sustain programs aimed to improve the mental health of the county, Holy Cross will continue to participate in the ongoing needs assessment process to determine how we can play a role in improving outcomes in this area. Evaluation Criteria = 20 points Excerpt from Holy Cross Hospital 2011 CBR

18. V. Physicians 1. As required under HG 19-303, provide a written description of gaps in the availability of specialist providers, including outpatient specialty care, to serve the uninsured cared for by the hospital. Evaluation Criteria = 5 points • According to “County Health Rankings” collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin, Peninsula Regional’s primary service area has considerably fewer primary care physicians than the Maryland average… Wicomico County has the best ratio of population to primary care physicians of 988:1, which is still 38% below the Maryland average, and Somerset County has the worst at 1,867:1, which is 160% below Maryland’s average. 2. If you list physician subsidies in your data category C of the CB Inventory Sheet, please indicate the category of subsidy and explain why the services would not otherwise be available. • Category: Hospital based physicians with whom the hospital has an exclusive contract C10 Pediatric Specialties – Without this contracted services we would not be able to provide local pediatric endocrinology and cardiology care. The patient population is such that there is a need but couldn’t support a local full time physician practice. Excerpts from Peninsula Regional Medical Center FY 2011 CBR

19. VI. Appendices • Describe your Financial Assistance Policy (FAP) • How does the hospital inform patients about the FAP? • Does the hospital provide a plain language summary? • Does the hospital publicly post the FAP? • Include copies of your hospital’s FAP and Patient Information Sheet in accordance with HG 19-214.1(e) Evaluation Criteria = 15 points • Include the hospital’s mission, vision, and value statement(s) Evaluation Criteria = 5 points

20. The Community Benefit Reporting Tool

26. Anatomy of a Community Benefits Report QUESTIONS?